Oregon Medicare Supplements

MEDICARE Part D Prescription Drug Plan Options:

Medicare Part D is not that difficult to understand. There has been a lot of confusing information in the news about Part D Medicare. You will pay a monthly premium to the Insurance Company you select for your coverage. Depending on the plan, you may have a $310 deductible before it starts to cover your prescriptions. The Initial coverage is paid at a minimum of 75% towards your prescriptions (some plans may pay more or use co-pays). Once you have spent $2,830 out of your pocket towards prescriptions, you reach the "Donut Hole". At this point you will pay 100% of your prescriptions until you reach $4,550. This amount includes co-pays and the deductible, if you have one. Be aware that there are some "premium plans" which offer some coverage through the "Donut Hole". This is where the Catastrophic Benefit begins. The Catastrophic Benefit pays a minimum of 95% of your prescriptions for the remainder of the year.

Please remember that if you select a Non-PFFS Medicare Advantage plan (i.e. PacifiCare Secure Horizons), you will not need to look further than your carrier to find your Medicare Part D plan. Your Medicare Advantage company will offer you the Part D plans you can select. If you were to try and purchase a Medicare Part D plan from another company, you would be dis-enrolled by your Medical Advantage plan by CMS (Medicare). Another option would be to switch to a different Medicare Advantage plan if you wished. This can also be done in the November 15th to January 1st enrollment period. You will then be locked in until the November 15th enrollment period.

Four Steps to Get Medicare Prescription Drug Coverage

To help people with Medicare take advantage of the new Medicare prescription drug coverage, there are four steps for people with Medicare to think about while making a decision:

1. Getting Started

The decision to get Medicare prescription drug coverage depends on how someone with Medicare pays for their drugs now and how they get their Medicare coverage. Most people with Medicare pay for drugs and get their Medicare in one of five ways:

• Original Medicare only, or Original Medicare and a Medigap ('Supplement') Policy without drug coverage. Medicare drug coverage will cover half of the costs for someone with this type of coverage now. Enhanced options are available that provide more coverage.
• Original Medicare and a Medigap ('Supplement') Policy with drug coverage. The new Medicare drug coverage will generally provide much more comprehensive coverage at a lower cost.
• Retiree or union coverage. In most cases, people with good retiree or union coverage can continue to get it, with new financial support from Medicare.
• Medicare Advantage Plan (like a PFFS) or other Medicare Health Plan, which already include drug coverage and other extra benefits.
• Dual coverage from Medicare with Medicaid drug coverage. These people will automatically get comprehensive prescription drug coverage from Medicare, starting on January 1.

NOTE: People with limited income and resources who don't have Medicaid, may qualify for extra help that may pay for about 95% of their drug costs. Visit Extra Help For People with Limited Income and Resources for more information.

Because the way that Medicare drug coverage works depends on a person's current coverage, Medicare has specific information available to help everyone, regardless of their coverage. These resources include the CMS brochure What Medicare Prescription Drug Coverage Means to You: A Guide to Getting Started and the Medicare & You 2010 Handbook mailed to all people with Medicare this fall. The brochure and other free Medicare publications are available by visiting www.medicare.gov or calling 1-800-MEDICARE. People with Medicare should also look for and review information from their current insurer about how their current coverage will work with the Medicare prescription drug coverage.

To find out how much someone with Medicare can save with Medicare prescription drug coverage, visit the Medicare Prescription Drug Plan Cost Estimator at www.medicare.gov . This information is also available by calling 1-800-MEDICARE.

2. Determining what matters most and reviewing plan options

Once someone decides that they want prescription drug coverage, they should think about what matters most to them. There are a range of plan options available, so they can focus on the kind of coverage they prefer. There are two ways to get Medicare drug coverage. They can add drug coverage to the traditional Medicare plan through a 'stand alone' prescription drug plan. Or they can get drug coverage and the rest of their Medicare coverage through a Medicare Advantage plan, like an MCO or PPO, which typically provides more benefits at a significantly lower cost through a network of doctors and hospitals. No matter what type of plan they choose, they can choose a plan that reflects what they want in terms of cost, coverage and convenience.

• Cost: What a person with Medicare pays for the coverage, including premiums, deductible, and payments for drugs.
• Coverage: What benefits are provided (like coverage in the 'coverage gap' and other coverage enhancements), which drugs are covered and the rules (like prior authorization) for getting those drugs.
• Convenience: Which pharmacies are part of the plan and whether the plan has a mail-order option.
  

The Centers for Medicare & Medicaid Services has created an online resource, Landscape of Local Plans , located at www.medicare.gov , that helps people with Medicare find Medicare prescription drug plans by state or Medicare Advantage plans with prescription drug coverage by county that meet their needs based on cost, coverage, and convenience.

3. Choosing a plan

There are many ways to choose a plan. Some may rely on advice from people they know or trust, or choose a plan they are already familiar with, or use the Landscape of Local Plans located on www.medicare.gov to find a plan that meets their needs. All of the plan options must meet or exceed Medicare's standards for coverage, including coverage for medically necessary drugs.

If people want to make more specific plan comparisons based on what matters to them, they can get personalized information from the Medicare Prescription Drug Plan Finder . The Medicare Prescription Drug Plan Finder can be accessed at www.medicare.gov or through a customer service representative at 1-800-MEDICARE, or through the many organizations working with Medicare to help people take advantage of the new drug coverage.

4. Enroll

1. You can join when you first become eligible for Medicare (three months before the month you turn age 65 until three months after the month you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments.
2. If you didn't join when you were first eligible, you can join between November 15 and December 31 of each year. Your coverage will begin on January 1 of the following year. Generally, your next opportunity to make a change will be between November 15 and December 31 of each year.

Note: In certain situations, you may be able to join a Medicare Advantage plan or Medicare Prescription Drug Plan at other times. For example, if you:

• Move out of your plan's service area
• Have both Medicare and Medicaid
• Live in, or move into or out of an institution (such as a nursing home)
• Have creditable prescription drug coverage and that coverage ends
• Lost employer coverage or your plan coverage is no longer available in your area

You can switch to another Medicare Advantage plan during the Open Enrollment Period (OEP) from January 1 to March 31 of any year, but you can't join or drop Medicare Prescription Drug coverage during that time. For instance, if you are in a Medicare Advantage plan with prescription drug coverage, you could return to the Original Medicare Plan, but you'd have to also join a Medicare Prescription Drug Plan at the same time.